Aetna considers genetic testing medically necessary to establish a molecular diagnosis of an inheritable disease when all of the following are met:. See Appendix for List 1 : Suspected Diagnoses. Aetna considers adenomatous polyposis coli APC genetic testing medically necessary for any of the following indications:. Aetna considers APC genetic testing experimental, investigational, or unproven for all other indications because its effectiveness for indications other than the ones listed above has not been established.
Aetna considers AR androgen receptor gene sequence analysis for AIS as medically necessary for the following indications below. Testing strategy: Begin with sequence analysis of AR. Aetna considers genetic testing for AIS experimental, investigational, or unproven for the identification of AR carriers in the general population and for all other indications because there is inadequate evidence in the published peer-reviewed clinical literature regarding its effectiveness.
Aetna considers genetic testing medically necessary to confirm a diagnosis of AS when the following criteria are met:. Mutation-specific genetic testing for ARVC is considered medically necessary for first or second-degree relatives of the index case following the identification of the ARVC-causative mutation in the index case. Aetna considers medically necessary preconception or prenatal carrier screening for persons of Ashkenazi Jewish ancestry with a panel of genetic tests recommended by the American College of Medical Genetics ACMG :.
If only one partner is of Ashkenazi Jewish ancestry, then testing of that partner is considered medically necessary. Testing of the other partner is considered medically necessary only if the result of testing of the Ashkenazi Jewish partner is positive.
Aetna considers CADASIL genetic testing experimental, investigational, or unproven for all other indications because its effectiveness for indications other than the ones listed above has not been established. Aetna considers genetic testing for cadherin-1 e-cadherin, CDH1 mutations for hereditary diffuse gastric cancer DGC is considered medically necessary when any of the following criteria is met:. Cadherin 1 testing is considered experimental, investigational, or unproven for confirming the clinical diagnosis of HDGC and for other indications because there is inadequate evidence in the peer-reviewed published clinical literature regarding its effectiveness.
